Site Location ____________________________________________________

Property Owner___________________________________________________

Application for: Roofing Siding Roofing & Siding
Contractor information (contractor must be registered in Upper Providence):

Name _______________________________________

Address_____________________________________________________

Phone number_____________ UPT Contractor registration number_______

If subcontractor, provide name of general contractor___________________

Estimated cost of job- $_____________@ $20/$1,000  of cost or  faction thereof (+ $4.00 PA State Training Fee to be added) =  $___________ (fee)

Reminder: Permit fee must accompany this application.
Contact the Upper Providence Township office
www.upperprovidence.org or call 610-565-4944 for further information.

Conditions:

• All work is to be done in accordance with the 1996 B.O.C.A. Code, which has
  been adopted by the Township with several additions and insertions.
• No dumpsters are to be located within the Township's right- of- way
• No overlay of wooden shingles and/or shakes.
• Call for final inspection (610-565-4944).

Description of work to be done:
_________________________________________________________________

Signature of Applicant______________________________

-------------------------------------------------------FOR OFFICE USE ONLY -------------------------------------------------------

Permit fee $_______ Date paid_____ Check #________ Received by_______ Permit #___________

Issuing Officer:__________________________________